Provider Demographics
NPI:1730774464
Name:COLWELL, MAGGI DIANE (MS, ATR-BC)
Entity type:Individual
Prefix:
First Name:MAGGI
Middle Name:DIANE
Last Name:COLWELL
Suffix:
Gender:F
Credentials:MS, ATR-BC
Other - Prefix:
Other - First Name:MAGGI
Other - Middle Name:DIANE
Other - Last Name:HORSEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATR-BC
Mailing Address - Street 1:1693 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3633
Mailing Address - Country:US
Mailing Address - Phone:614-800-9508
Mailing Address - Fax:
Practice Address - Street 1:1693 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3633
Practice Address - Country:US
Practice Address - Phone:614-800-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATG221221700000X
DEAT-0010005221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist